Abstract: The objective present study is to report a rare case of bilateral small kidneys in elderly female age 75 years. This study was done in Bangalore district Bangalore. This was studied was during the month of April 2013. An elderly female aged 75 years old underwent general examination as outpatient at St .John’s Medical College Hospital for her extreme weakness heaviness in the chest and breathlessness since one month. A detailed history revealed that she is non diabetic, non hypertensive, and not suffering from ischemic heart disease. There was a definite family history of congenital renal anomalies .Her second daughter aged 50 years has absence of right kidney since birth. Her elder son had Horse shoe shaped kidneys associated with diabetes and hypertension, Thorough examination was done here and investigated She underwent all investigation like complete haemogram, 2D ECHO and ultrasound of abdomen which revealed Bilateral small kidneys with grade 1 parenchymal changes and left renal exophytic cyst. Renal agenesis and renal aplasia are known to cause anomalies of kidneys like congenital solitary kidneys which are more prone for renal failure. Familial history of anomalies and associated anomalies are known to cause higher incidence of renal agenesis.than renal aplasia . There is difficulty in differential diagnosis of renal agenesis and renal aplasia.It is said Renal agenesis which is diagnosed clinically is more due to renal aplasia. This study on bilateral small kidneys is rare may due to renal aplasia which is diagnosed clinically by ultrasonographically, which is very rare entity; hence studied and reported..